Unilateral Extrapedicular Percutaneous Kyphoplasty Combined with 6-Screw Fixation to Treat Osteoporotic Thoracolumbar Burst Fracture.

Abstract

Optimal treatment for osteoporotic thoracolumbar burst fractures (TLBFs) remains controversial. Therefore, identifying a more effective and feasible method to simplify reported surgical procedures remains crucial. In this study, we aimed to assess the clinical and radiological outcomes of a novel hybrid surgery involving unilateral extrapedicular percutaneous kyphoplasty combined with six-screw fixation in patients with osteoporotic TLBFs. Fifty-one patients who underwent this procedure at 2 institutions between January 2019 and October 2023 were retrospectively enrolled. Back pain and function were evaluated using the visual analog scale and Oswestry disability index scores, respectively. Radiological outcomes included the anterior vertebral height, posterior vertebral height, and local kyphotic angle. The intraoperative data and complications were recorded. All patients underwent successful treatment. The postoperative visual analog scale and Oswestry disability index scores significantly decreased (P < 0.05) and continued to decrease at the last follow-up (P < 0.05). Postoperative anterior vertebral height of injured vertebrae, posterior vertebral height of injured vertebrae, and local kyphotic angle values were significantly corrected compared with the respective preoperative values (P < 0.05). No obvious loss of correction was observed during follow-up (P > 0.05). In 50 patients (98%), the cement diffused across the vertebral body midline. Three patients (5.8%) experienced asymptomatic cement leakage. No patient experienced other severe complications, including injuries to the segmental lumbar arteries and nerve roots, internal fixation failures, or deep infections. The extrapedicular puncture technique avoided internal fixation obstruction and simplified the surgical procedure. This novel hybrid surgery showed good clinical and radiological outcomes. Therefore, it is considered safe and effective for osteoporotic TLBFs.